UNDER SECRETARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, DC

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1 WASHINGTON, DC PERSONNEL ANO READINESS The Honorable Daniel K. Inouye Chainnan Subcommittee on Defense Committee on Appropriations United States Senate Washington, DC Dear Mr. Chainnan: APA 27 3n2 This enclosed report responds to House Report , page 261, accompanying H.R. 2219, the Department of Defense Appropriations Bill, 20 l 2. The House Appropriations Committee requested the Secretary of Defense examine the feasibility ofelectronically The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chairmen ofthe congressional defense committees. The report includes the current status oftransmitting records ofprescription medication problem, and a projected plan of action. While the final report was due no later than February Thank you for your interest in the health and well-being of our Service members, The Honorable Thad Cochran Vice Chairman

2 ~OODEFENSEPENTAGON PERSONNEL ANO REAOINESS The Honorable Daniel K. Inouye Chairman Committee on Appropriations United States Senate Washington, DC APR 27 D2 This enclosed report responds to House Report , page 261, accompanying H.R. 2219, the Department ofdefense Appropriations Bill, The House Appropriations Committee requested the Secretary of Defense examine the feasibility ofelectronically transferring prescription data from theater to the Department's central phannacy data repository. The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chairmen of the congressional defense committees. The report includes the current status oftransmitting records ofprescription medication problem, and a projected plan ofaction. While the final report was due no later than February Thank you for your interest in the health and well-being of our Service members, The Honorable Thad Cochran Vice Chairman

3 PERSONNEL ANO READINESS The Honorable Carl Levin Chairman Committee on Armed Services United States Senate Washington, DC APR 27 20t2 This enclosed report responds to House Report I l 2-110, page 261, accompanying H.R. 2219, the Department of Defense Appropriations Bill, The House Appropriations Committee requested the Secretary of Defense examine the feasibility of electronically The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chairmen ofthe congressional defense committees. The report includes the current status oftransmitting records of prescription medication problem, and a projected plan ofaction. While the final report was due no later than February Thank you for your interest in the health and well-being of our Service members, The Honorable John McCain Ranking Member

4 PERSONNEL AND REAOINESS The Honorable Howard P. Buck" McKean Chairman APR Committee on Armed Services U.S. House of Representatives Washington, DC This enclosed report responds to House Report l 0, page 261, accompanying H.R. 2219, the Department of Defense Appropriations Bill, The House Appropriations Committee requested the Secretary of Defense examine the feasibility ofelectronically The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chairmen ofthe congressional defense committees. The report includes the current status oftransmitting records of prescription medication problem, and a projected plan of action. While the final report was due no later than February Thank you for your interest in the health and well-being of our Service members, The Honorable Adam Smith Ranking Member

5 PERSONNEL AND READINESS The Honorable Harold Rogers Chairman Committee on Appropriations U.S. House of Representatives Washington, DC APA This enclosed report responds to House Report , page 261, accompanying H.R. 2219, the Department of Defense Appropriations BiII, The House Appropriations Conunittee requested the Secretary of Defense examine the feasibility ofelectronically The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chainnen ofthe congressional defense committees. The report includes the current status of transmitting records ofprescription medication problem, and a projected plan ofaction. While the final report was due no later than February Thank you for your interest in the health and well-being ofour Service members, Th e Honorable Norman D. Dicks Ranking Member

6 PERSONNEL ANO READINESS The Honorable Jim Webb Chairman APR 27 a,j2 Subcommittee on Personnel Committee on Armed Services United States Senate Washington, DC This enclosed report responds to House Report page 261, accompanying H.R. 2219, the Department of Defense Appropriations Bill, The House Appropriations Committee requested the Secretary of Defense examine the feasibility of electronically The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and l have been asked to respond. A similar letter is being sent to the Chairmen of the congressional defense corrunittees. The report includes the current status of transmitting records of prescription medication problem, and a projected plan ofaction. While the final report was due no later than February Thank you for your interest in the health and well-being of our Service members, cc : The Honorable Lindsey Graham Ranking Member

7 PERSONNEL AND REAOINESS The Honorable Joe Wilson Chairman APR Subcommittee on Military Personnel Committee on Armed Services U.S. House of Representatives Washington, DC This enclosed report responds to House Report 1 l 2-110, page 261, accompanying H.R. 22 l 9, the Department of Defense Appropriations Bill, 20 l 2. The House Appropriations Committee requested the Secretary of Defense examine the feasibility of electronically The committee further reqµested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potentiaj obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chairmen of the congressional defense committees. The report includes the current status of transmitting records ofprescription medication problem, and a projected plan of action. While the final report was due no later than February Thank you for your interest in the health and well-being of our Service members, The Honorable Susan A. Davis Ranking Member

8 PERSONNEL AND READINESS The Honorable C.W. Bill Young APA Chairman Subcommittee on Defense Committee on Appropriations U.S. House of Representatives Washington, DC This enclosed report responds co House Report l 0, page 261, accompanying H. R. 2219, the Department of Defense Appropriations Bill, The House Appropriations Committee requested the Secretary of Defense examine the feasibility of electronically The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescribing drug data. This issue falls under my purview, and I have been asked to respond. A similar letter is being sent to the Chainnen ofthe congressional defense committees. The report includes the current status of transmitting records ofprescription medication problem, and a projected plan ofaction. While the final report was due no lacer than February Thank you for your interest in the health and well-being ofour Service members, The Honorable Norman D. Dicks Ranking Member

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10 Report to Congress on The Growing Use of Pain Management Prescription Medications and the Transmission of Prescription Data (particularly in Theater) Preparation of this repon/scudy cost the Department of Defense a cotal of approximately $1,290 in Fiscal Year 2012.

11 BACKGROUND: House Report , page 261, to accompany H.R. 2219, the Department of Defense (DoD) Appropriations Bill, 2012, requested the Secretary of Defense examine the feasibility of electronically transferring prescription data from theater to the Department's central pharmacy data repository. The committee further requested the Assistant Secretary of Defense (Health Affairs) submit a report on the required steps and potential obstacles toward electronic transmission of prescription drug data. The report should include the current status of transmitting records of prescription medication from theater, the logistical obstacles that may exist, the resources required to ameliorate the problem, and a plan of action for establishing a more consistent electronic transmission process. A second subject of the report language asked that the report include what efforts the Department is taking to track prescription drugs that Service members obtain in the private sector and the status of cooperation with state controlled substance monitoring programs. PART I-PHARMACY DATA REPOSITORY: The DoD Pharmacy Data Transaction Service (POTS) is a centralized data repository that records information about prescriptions filled worldwide for DoD beneficiaries through Military Treatment Facility (MTF) pharmacies, TRICARE Retail Network Pharmacies and the TRlCARE Mail Order Pharmacy. The PDTS has processed more than 1.5 billion transactions in real time since it was fully implemented in The PDTS conducts online, real-time prospective drug utilization review (clinical screening) against a patient's complete medication history for each new or refilled prescription before it is dispensed to the patient. The clinical screenings identify such potential patient safety or quality issues as potential adverse reaction between two or more prescriptions, duplicate prescriptions, therapeutic overlaps and other alerts that can be immediately addressed to ensure the patient receives safe, quality care. In addition to the more than 100 million prescriptions processed in fiscal year (FY) 2011 through retail, mail and MTF pharmacies, the PDTS also captures member-submitted claims (paper claims) for reimbursement, as well as claims from the Department ofveterans Affairs (VA) for dual-eligible members via information sharing processes. The PDTS, however, does not capture prescription information for a DoD beneficiary who chooses not use the TRICARE benefit (i.e., pays cash or uses other health insurance) for a prescription in a retail pharmacy. CURRENT STATUS OF TRANSMITTING PRESCRIPTION DATA FROM THEATER: The TR[CARE Management Activity (TMA), Phannaceutical Operations Directorate (POD) and Defense Health Information Management System (DHIMS), along with the contractors that suppon PDTS and the Theater Medical Data Store (TMDS) have developed an interface that will allow PDTS to capture ambulatory prescription information on Service members in theater via TMDS. In December 2011, this team established connectivity between TMDS and PDTS and the first file containing theater prescription data was received by PDTS. During the initial processing of the first production file, the team identified an issue ofduplicate 2

12 prescription data. To ensure the integrity of the Service member's medication profile, the team recommended suspending inclusion of theater prescription data into POTS until the duplicate prescription data issue was corrected. The POD and DHIMS have been actively working to develop a technical approach that will eliminate the duplicate data. Once the solution is implemented, POTS will reinstate the inclusion oftheater prescription data and begin capturing historical data retroactively from April LOGISTICAL OBSTACLES: Currently there are no logistical obstacles identified. RESOURCES REQUIRED TO AMELIO RA TETHE PROBLEM: Resources are assigned to support the interface between TMDS and PDTS. PLAN OF ACTION: The POD and DHIMS are currently refining the prescription processing activities to isolate the unique theater medication records for each service member to ensure the accuracy of the POTS medication profiles. It is anticipated that the necessary changes will be completed by 2nd Quarter calendar year (CY) 2012 and theater prescription data will then be included in POTS. PART II-EFFORTS TO TRACK PRESCRIPTION DRUGS SERVICE MEMBERS OBTAIN IN THE PRIVATE SECTOR AND THE STATUS WITH STATE CONTROLLED SUBSTANCE MONITORING PROGRAMS: The TRICARE Mail Order Pharmacy and Retail Network Pharmacies currently supply prescription data to State Prescription Drug Monitoring Programs (PMDPs). The TMA and the Services are assessing current policies, Federal legislation, and privacy considerations (i.e., Health Insurance Portability and Accountability Act (HIP AA)) to determine the best approach for participation in the various PMDPs by MTF pharmacies. Also, the TMA, POD, and the contractor that supports POTS are determining the feasibility of providing MTF prescription data to each State's PMDP. The challenge remains that there is not a National standard for PMDPs, and the state programs are at varying levels of maturity, operationally and technologically. The POD is assessing various technical approaches and levels of effort (i.e., funding requirements) to determine the best solution for MTF data sharing with state PDMPs. CONCLUSION: While the POTS is a robust and comprehensive prescription database that has been operational since 2001, TMA is continuing to explore innovations in technology to improve the quality ofcare provided to TRI CARE beneficiaries. 3

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